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Bipolar Disorder in Children and Adolescents

(Manic-Depressive Illness)


Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023

In bipolar disorder, periods of intense elation and excitation (mania) alternate with periods of depression and despair. Mood may be normal in between these periods.

  • Children may rapidly go from being excited, happy, and active to being depressed, withdrawn, and sluggish or full of rage and violent.

  • Doctors base the diagnosis on symptoms and results of psychiatric tests.

  • The diagnosis of bipolar disorder in young children is very controversial.

  • Treatment may include mood-stabilizing medications to treat mania, antidepressants to treat depression, and psychotherapy.

Children normally have fairly rapid mood swings, going from happy and active to glum and withdrawn. These swings rarely indicate a mental health disorder. Bipolar disorder is far more severe than these normal mood changes, and the moods last much longer, often for weeks or months.

Bipolar disorder is rare in children. In the past, bipolar disorder was often diagnosed when young children (aged 4 to 11 years) became intensely irritable many times a day. Such children are now thought to have a disruptive mood dysregulation disorder Disruptive mood dysregulation disorder Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more instead.

The cause is unknown, but a tendency to develop bipolar disorder can be inherited. Chemical and anatomic abnormalities in the brain may be involved. In children with the disorder, stress may trigger an episode. Also, certain other disorders, such as overactive thyroid gland or attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child’s age that interferes with functioning... read more (ADHD), can cause some similar symptoms or worsen the condition. Certain medications (for example, cocaine Cocaine Cocaine is an addictive stimulant drug made from leaves of the coca plant. Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful. High doses... read more , amphetamines Amphetamines Amphetamines are stimulant drugs that are used to treat certain medical conditions but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce euphoria... read more , phencyclidines Ketamine and Phencyclidine (PCP) Ketamine and phencyclidine are chemically similar drugs used for anesthesia but are sometimes used recreationally. Ketamine is available in powder and liquid form. The powder can be snorted... read more , and certain antidepressants Medications for Treatment of Depression Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more ) and toxins in the environment (such as lead) can cause similar symptoms or worsen the condition.

Research also indicates that there is an increased risk of developing certain psychotic disorders (namely, bipolar disorder and schizophrenia) among adolescents who use cannabis products. This increased risk is not explained by genetic factors. There is concern that the recent legalization of marijuana may give adolescents (and their parents) a false sense of security about using this drug.


The main symptoms are episodes of feeling elation and excitement of varying degrees (intense [mania] and less intense [hypomania]) that alternate with episodes of depression, which may occur more often. Children may go through intense changes in mood.

During a manic episode, sleep is disturbed, and children may become aggressive. They may have a very positive mood or be very irritable. They may talk rapidly. Their thoughts may race. They may have grandiose thoughts. For example, children may feel they have some great talent or have made an important discovery. Their judgment may be impaired, and adolescents may behave irresponsibly—for example, by becoming sexually promiscuous or driving recklessly. Younger children may have dramatic moods, but these moods often last only a few moments. School performance often deteriorates.

During an episode of depression, children with bipolar disorder, like those with depression alone, feel excessively sad and lose interest in their usual activities. They may think and move slowly and sleep more than usual. Feelings of hopelessness and guilt may overwhelm them.

Symptoms often begin gradually. However, before the disorder develops, children typically have been very temperamental and difficult to manage.


  • A visit with a doctor or behavioral health specialist

  • Sometimes questionnaires about symptoms

  • Tests to check for other causes of symptoms

Doctors base the diagnosis of bipolar disorder on a description of typical episodes by children and their parents. Doctors try to determine whether something, such as severe stress, triggered the episode.

Distinguishing bipolar disorder from other disorders is important. For example, both bipolar disorder (in a manic episode) and attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child’s age that interferes with functioning... read more (ADHD) can cause children to be very active, but doctors can usually distinguish the disorders because most children with ADHD, unlike those with bipolar disorder, do not have intense mood changes.

Doctors determine whether children are taking any drugs that could contribute to the symptoms. Doctors may also check for signs of other disorders that may contribute to or cause the symptoms. For example, they may do blood tests to check for an overactive thyroid gland Diagnosis Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more Diagnosis .


  • Second-generation antipsychotics

  • Mood-stabilizing medications

  • Sometimes antidepressants

  • Psychotherapy

In bipolar disorder, episodes of mania and agitation are treated with second-generation antipsychotics and mood-stabilizing medications.

Episodes of depression are treated with

  • Second-generation antipsychotics plus selective serotonin reuptake inhibitors [SSRIs]

  • Lithium

Antidepressants are not used alone but in combination with the antipsychotics or lithium.

Individual and family psychotherapy helps children and their families cope with the consequences of the disorder. Psychotherapy can help adolescents, who are prone to not follow their drug regimen, continue to follow it. If adolescents have mild to moderate symptoms and follow their drug regimen, they usually do well.

Did You Know...

  • Antipsychotic medications are the treatment of choice for children and adolescents with bipolar disorder.

  • Treatment with lithium can decrease suicidal thoughts and behaviors.


For adolescents with bipolar disorder, the prognosis worsens with each recurrence, so complete, thorough treatment is very important. Factors that increase the risk of recurrence include early age of onset, severity of symptoms, family history of bipolar disorder, and lack of treatment or failure to adhere to treatment.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Abilify, Abilify Asimtufii, Abilify Discmelt, Abilify Maintena, Abilify Mycite, Aristada
Zyprexa, Zyprexa Intramuscular, Zyprexa Relprevv, Zyprexa Zydis
Seroquel, Seroquel XR
PERSERIS, Risperdal, Risperdal Consta, Risperdal M-Tab, Rykindo, UZEDY
Eskalith, Eskalith CR, Lithobid
Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR, Subvenite
Carbatrol, Epitol , Equetro, Tegretol, Tegretol -XR
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